Missouri

In advance of the April 12th Senate Insurance and Banking hearing on HCR HB 1677, NACDS submitted a letter supporting certain provisions of the legislation that would strengthen Missouri’s PBMs laws to enhance patients’ ability to receive pharmacy care from their pharmacy of choice and improve provisions for fair and equitable standards for the management of pharmacy benefits. In our letter, NACDS specifically called out support for the provisions that would prohibit PBMs from preventing, penalizing or restricting patients’ ability to obtain services from a contracted pharmacy; the provisions that would enhance the appeals process to requiring PBMs to increase a pharmacy’s reimbursement in instances when reimbursement is found to be below a pharmacy’s cost for purchasing a drug; and the provisions that would prevent PBMs from imposing unwarranted fees on claims related to administering a health plan.

For more information, contact NACDS’ Mary Staples at 817-442-1155.

2022-04-08T12:14:15-04:00April 8, 2022|Missouri|

Nebraska

Executive Order No. 22-02 — Continued Waivers to Facilitate Hospital Planning and Ensure Additional Healthcare Workforce Capacity — states “Executive Order No. 21-15, which is currently scheduled to expire on March 31, 2022, per [E]xecutive [O]rder No. 21-18, shall remain in effect through September 30, 2022.” See item 6 in Executive Order No. 21-15 suspending Neb. Rev. Stat. § 38-2866.01 and its implementing regulations “in order to permit pharmacists to have any number of pharmacist interns and pharmacy technicians under their supervision insofar as they determine it necessary within their professional discretion when administering vaccinations”.

Also in Nebraska, the Department of Health and Human Services announced the next COVID-19 Medicaid Provider call will take place on May 4 at noon (Central).

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

2022-04-08T12:13:10-04:00April 8, 2022|Nebraska|

New York

The State Education Department regulation expanding the pharmacist immunization authority which took effect on January 31, 2022, is set to expire on April 10. At the last Board of Regents meeting, the Board took emergency action effective April 11 to keep the regulation in effect until it can be permanently adopted at the Board May Meeting.

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

2022-04-08T12:12:02-04:00April 8, 2022|New York|

North Carolina

SPECIAL BULLETIN COVID-19 #242: Continued Reimbursement for COVID-19-Related Services for the Uninsured. Effective April 4, 2022

NC Medicaid continues to reimburse providers for COVID-19 related services for the NC Medicaid Optional Eligibility Group (which includes the uninsured (MCV) and MAFDN Family Planning Group). This program was initiated in 2020 for COVID-19 and expanded by the America Rescue Plan Act to include COVID-19 treatment and vaccination. NC Medicaid will continue to operate this program through the federal public health emergency.

It was recently announced that the Health Resources and Services Administration (HRSA) -led initiative to reimburse for COVID-19 testing and treatment will end. This program also reimbursed health care providers for delivering COVID-19 testing, treatment and vaccines to those without health insurance. As of March 22, 2022, the program stopped accepting claims for testing and treatment services. On April 5, 2022, the program will stop accepting claims for vaccine administration.

This bulletin services as a reminder that the two programs are separate entities, and that NC Medicaid will continue to reimburse providers who deliver COVID-19 treatment, testing, and vaccine administration for the uninsured in the state. To be eligible for the program, individuals must:

  1. Enroll in Medicaid for the uninsured (MCV) group or MAFDN Family Planning.
  2. Be uninsured.
  3. Be a resident of North Carolina.
  4. Meet the citizenship and legal immigration status requirements of the Medicaid program.

Detailed eligibility requirements may be found in SPECIAL BULLETIN COVID-19 #206.

Also in North Carolina, The Board of Pharmacy has completed a rulemaking to amend Rule .1816, now titled “Centralized Pharmacy Services.” The amended rule broadens the availability of remote medication order processing (“RMOP”) arrangements among pharmacies to all pharmacy practice types. The full rule is found here: 21 NCAC 46.1816

The new RMOP provisions became effective March 1, 2022. However, the Board’s Expanded Emergency Services Waiver, issued on March 17, 2020, because of the COVID-19 public health emergency, authorized expanded RMOP arrangements: Expanded Emergency Services Waiver

Pharmacies may continue to operate RMOP arrangements pursuant to the waiver until June 1, 2022. Beginning June 1, 2022, the Board will enforce the Rule .1816-based RMOP requirements. To assist pharmacies transitioning to the rule based RMOP requirements, Board staff have prepared two guidance documents.

The first, http://www.ncbop.org/PDF/GuideToInterPharmacyRMOP.pdf – provides a detailed overview of the revised rule governing inter-pharmacy RMOP arrangements. Please note, this guidance document only concerns RMOP services arranged between two pharmacies. The Board has proposed a new rule (Proposed New Rule 21 NCAC 46.2515) authorizing intra-pharmacy remote services (i.e., a pharmacy uses its own personnel to provide off-site services). Once that rulemaking is complete, the Board staff will provide a separate guidance document on that topic. In the meantime, intra-pharmacy remote services are allowed under the Expanded Emergency Services Waiver linked above.

The second, http://www.ncbop.org/PDF/HowToRegisterAsNABPVerifyHolder.pdf – provides detailed instructions on how out-of-state pharmacists who are performing RMOP services and who are not individually licensed to practice pharmacy in North Carolina may obtain an NABP Verify credential and register with the Board of Pharmacy, as required by revised Rule .1816.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

2022-04-08T12:10:37-04:00April 8, 2022|North Carolina|

North Dakota

The Department of Health has developed the following COVID-19 vaccine resources:

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

2022-04-08T12:07:30-04:00April 8, 2022|North Dakota|

Ohio

Medicaid (ODM)announced that Myers and Stauffer have begun sending acquisition cost surveys to pharmacies to help them determine Ohio Average Acquisition Cost (OAAC). ODM intends to use OAAC as part of the “lower of” calculation for ingredient cost reimbursement, to include NADAC and Usual and Customary, when they implement “The Next Generation of Managed Care.” Completed surveys are due April 30 and can be submitted by email, U.S. Post, or fax, as noted below, though electronic submission is preferred.

  • Email OHSurveys@mslc.com. The email subject link should read: “Ohio Pharmacy Survey.”
  • Mail Myers and Stauffer LC, Attn.: Ohio Pharmacy Survey 800 East 96th Street, Suite 200 Indianapolis, IN 46240.
  • Fax 317-566-3203. On the cover page, please include “ATTN – Ohio Pharmacy Survey.”

To learn more about the Next Generation of Medicaid managed care, visit Ohio Medicaid Single Pharmacy Benefit Manager (SPBM) | Ohio Medicaid Managed Care or email ODM at MedicaidSPBM@medicaid.ohio.gov.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

2022-04-08T12:06:29-04:00April 8, 2022|Ohio|

Oregon

The Oregon Health Authority is implementing changes to the Prior Authorization Guide and the Preferred Drug List, including select over-the-counter product classes, to ensure the safe and appropriate use of cost-effective prescription drug for Oregon Health Plan’s fee-for-service recipients. his is a temporary rule effective April 1, 2022, through June 25, 2022.

Also in Oregon, the Oregon Health Authority issued a Notice of Proposed Rulemaking, making permanent changes to the Prior Authorization Guide and the Preferred Drug List, including select over-the-counter product classes, currently in effect as a temporary rule effective April 1, 2022, through June 25, 2022. Comments are due 5:00 p.m. on May 21.

Finally in Oregon, the Board of Pharmacy posted a REVISED agenda and meeting materials for the April 13-15 meeting.

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

2022-04-08T12:02:35-04:00April 8, 2022|Oregon|

Tennessee

Please see the updates to the PDL, Clinical Criteria, and Interim Criteria below for April 2022. These changes went into effect on April 1st.

  • BaG additions: Combigan
  • Added to preferred: naloxone, Valtoco, glycopyrrolate solution, Myfembree
  • Added to non-preferred: Dartisla ODT, Eprontia, Xarelto suspension, Xenleta, Brexafemme, nitazoxanide, Elepsia XR, Azstarys, adapalene/benzoyl peroxide, carglumic acid, Zokinvy, Palforzia, Lumakras, Tepmetko, Qinlock, bimonidine/timolol, Bronchitol
  • Added to interim: Recorlev, Tarpeyo, Livmarli, Trudhesa, Tyrvaya, Skytrofa, Besremi, Tavneos, Adbry, Livtencity
  • Modified criteria/quantity limits for Adderall, Adderall XR, Adefovir, Adhansia XR, Adzenys ER solution, Adzenys XR ODT, amphetamine ER suspension, Ancobon, Arikayce, Baraclude solution, clonidine ER, Cotempla XR ODT, Cresemba, Daytrana, Desoxyn, Dexedrine spansule, dexmethylphenidate XR, dextroamphetamine soln, Dificid tablet and suspension, doxycycline hyclate 20mg, Dyanavel XR, Evekeo tab & ODT, flucytosine tablets, Focalin, Fuzeon, Hepsera, Intuniv, Isentress HD, itraconazole, Jornay PM, ketoconazole, linezolid suspension, Lumakras, methamphetamine, Methylin solution, methylphenidate chewable, methylphenidate ER, methylphenidate SA OSM, methylphenidate XR ODT, Mycobutin, Mydayis ER, Nuzyra, Oravig, Pegasys syringes, Pegasys vials, Qelbree, Qinlock, Quillichew ER, Quillivant XR, Relexxii, Ritalin, Ritalin LA, Sporanox, terbinafine tablets, Tybost, Vemlidy, Xenleta, Zenzedi, Zyvox suspension, Zyvox tablets.

Additionally, these documents can be found on the TennCare website.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

2022-04-08T11:57:19-04:00April 8, 2022|Tennessee|

Texas

NACDS attended the Dallas County Medical Society’s 139th Annual Dinner and Awards ceremony at the Frontiers of Flights Museum on April 6th honoring chain pharmacies and pharmacists from Kroger Health and Albertsons/ Randall’s/Tom Thumb for their efforts at the beginning of the pandemic providing 20,000 COVID-19 vaccines administered to physicians who are not affiliated with a major health or hospital systems and their frontline office staff. Accepting the awards for chain pharmacies were Jeff Loesch, PharmD with The Kroger Company, and Jennifer Golden, PharmD with Albertsons Companies. This successful collaborative effort eventually led to multiple other opportunities throughout the pandemic for more chain pharmacies to work directly in Collin, Dallas, Denton Grayson, and Tarrant County Health Departments to administer COVID vaccines and tests.

People in the photos:
Dr. Philip Huang, Director, Health Authority, Dallas County Health, and Human Services Department
Jon Roth, CEO, Dallas County Medical Society
Jeff Loesch, PharmD, CHC
Jill Lester, PharmD, BCPS, BCACP
Jennifer Golden, RPh.
Emad Besslay, MPharm

For more information, contact NACDS’ Mary Staples at 817-442-1155.

2022-04-08T12:01:13-04:00April 8, 2022|Texas|

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